People who are unable to work due to injury or illness, may be eligible to claim a lump sum for total and permanent disablement (TPD) in addition to any compensation benefits.
What is TPD?
Most people have TPD insurance coverage through their superannuation funds and are unaware of this. Your superannuation statement usually shows the amount of coverage you have for death and TPD.
If in doubt, you can contact your superannuation fund who should be able to advise whether coverage is available.
How do I know if I am eligible to claim?
Every superannuation fund will have a different definition of TPD. A typical definition requires you to be unable to work in your own occupation because of injury or illness and satisfy the insurer that you are unlikely ever to return to any gainful employment for which you are reasonably qualified by your education, training and experience.
Some definitions are harder to satisfy than others and there are many court decisions interpreting the wording of the different policies. It is imperative you obtain the definition of TPD that applied at the time of your disablement, that you understand what you are required to prove, and you ensure all the evidence you submit is consistent with that definition.
Is there a waiting period?
Every fund is different, but usually you have to be off work for a period of 3-6 months before making a claim.
How much money will I receive?
Everyone has a different level of coverage. Your superannuation statements can give you an idea of the insured amount. In many cases it can be hundreds of thousands of dollars. The closer you are to retirement, the lower the insured amount.
Is there a time limit to make a claim?
Generally no. Even if you ceased work a long time ago, you may still be eligible to make a claim.
How do I make a claim?
You can contact your superannuation fund and ask them to send you out the relevant claim forms and documents or you can engage a lawyer to assist you with the process.
It is not usually a good idea to complete the forms without legal assistance because:
the insurer will often request further documents, one at a time, delaying the decision making, sometimes for years; and
if you do not understand what documents you need to satisfy the definition of TPD and prove your claim, you may have your claim rejected.
An experienced lawyer will understand the requirements of your superannuation fund’s TPD definition, gather and assess the evidence and provide you with proper advice about the prospects of success, advise you about any steps you can take to increase your chances of success and will provide full documentation to the insurer upfront so that your claim can be determined sooner.
Best of all, you won't have to leave the comfort of your home to visit a lawyer's office. We can manage your claim by telephone and electronic communication.
What if my claim has been rejected?
If the claim is rejected it is important to get legal advice about requesting a review as soon as possible.
What about legal costs?
Mortimer Fox Lawyers handles TPD claims on a no-win/no-fee basis. That means if you don't get paid, we don't get paid. In addition, we will agree on a fixed fee for the work so you know exactly what it will cost when your claim is approved.
DISCLAIMER: This blog is made available by Mortimer Fox Lawyers to give you general information and a general understanding of the law, not to provide specific legal advice. Unless otherwise stated, all information provided pertains to injuries sustained in or in connection with New South Wales. By using this blog you understand that there is no solicitor client relationship between you and Mortimer Fox Lawyers. This blog should not be used as a substitute for legal advice. If you require legal advice please contact us for an appointment.
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